Rehabilitation Of Spinal Cord Injury Patients Research Articles

Rehabilitation of Spinal Cord Injury: WFNS Spine Committee Recommendations.

Spinal cord injury (SCI) is accompanied by a significant number of complications associated with damage to the spinal cord, gross functional impairments leading to limited self-care and movement, leading to a high level of disability, social and psychological maladaptation of the patients. Besides, pain and spasticity negatively affect rehabilitation programs. This search was conducted in PubMed/MEDLINE database. All studies published in English language (n = 16,297) were considered for inclusion. Of all studies evaluating rehabilitation in SCI patients (n = 80) were included. Based on the literature review the faculty of the WFNS Spine Committee created statements covering different aspects of the contemporary rehabilitation process of the SCI patients. The prepared statements were subjected to discussions, followed by anonymous voting process by the members of the WFNS Spine Committee. As result of the diccussions and the voting process the statements were modified and published as recommendations of the WFNS Spine Committee. The care for the SCI has gone a long way from the times after the World War II when these patients were considered hopeless in terms of any functional recovery, to the contemporary comprehensive rehabilitation programs. The rehabilitation is important part of the modern comprehencive treatment of SCI patients nowadays. The current manuscript reflects different aspects of the contemporary rehabilitaton process and decision makings, which were discussed by the faculty of the WFNS Spine Committee resulting in issuing of the following recommendations.

Beta-band oscillations as a biomarker of gait recovery in spinal cord injury patients: A quantitative electroencephalography analysis

ObjectiveThe gait recovery in spinal cord injury (SCI) seems to be partially related to the reorganization of cerebral function; however, the neural mechanisms and the respective biomarkers are not well known. This study tested the hypothesis that enhanced beta-band oscillations may be a marker of compensatory neural plasticity during the recovery period in SCI. We tested this hypothesis at baseline in SCI subjects and also in response to cortical stimulation with transcranial direct current stimulation (tDCS) combined with robotic-assisted gait training (RAGT). MethodsIn this neurophysiological analysis of a randomized controlled trial, thirty-nine patients with incomplete SCI were included. They received 30 sessions of either active or sham anodal tDCS over the primary motor area for 20 min combined with RAGT. We analyzed the Electroencephalography (EEG) power spectrum and task-related power modulation of EEG oscillations, and their association with gait function indexed by Walk Index for Spinal Cord Injury (WISCI-II). Univariate and multivariate linear/logistic regression analyses were performed to identify the predictors of gait function and recovery. ResultsConsistent with our hypothesis, we found that in the sensorimotor area: (1) Anodal tDCS combined with RAGT can modulate high-beta EEG oscillations power and enhance gait recovery; (2) higher high-beta EEG oscillations power at baseline can predict baseline gait function; (3) high-beta EEG oscillations power at baseline can predict gait recovery – the higher power at baseline, the better gait recovery; (4) decreases in relative high-beta power and increases in beta power decrease during walking are associated with gait recovery. ConclusionsEnhanced EEG beta oscillations in the sensorimotor area in SCI subjects may be part of a compensatory mechanism to enhance local plasticity. Our results point to the direction that interventions enhancing local plasticity such as tDCS combined with robotic training also lead to an immediate increase in sensorimotor cortex activation, improvement in gait recovery, and subsequent decrease in high-beta power. These findings suggest that beta-band oscillations may be potential biomarkers of gait function and recovery in SCI. SignificanceThese findings are significant for rehabilitation in SCI patients, and as EEG is a portable, inexpensive, and easy-to-apply system, the clinical translation is feasible to follow better the recovery process and to help to individualize rehabilitation therapies of SCI patients.

Characterization of Chronic Axonal Degeneration Using Diffusion Tensor Imaging in Canine Spinal Cord Injury: A Quantitative Analysis of Diffusion Tensor Imaging Parameters According to Histopathological Differences.

Diffusion tensor imaging (DTI) is more sensitive than conventional magnetic resonance imaging (MRI) for the identification of axonal degeneration. However, no study to date has used DTI to evaluate the severity of axonal degeneration in canine spinal cord injury (SCI). Therefore, the aim of this study was to characterize multi-grade axonal degeneration (mild, moderate, and severe) in a canine model of spinal cord compression injury using DTI. MRI data were obtained from 6 normal dogs and 5 dogs with lumbar SCI 78 days after SCI (L1-L3) using a 3 Tesla MRI scanner. For DTI, transverse multi-shot echo planar imaging sequences (b-value = 0; 800 s/mm2; 12 directions) were used. Regions of interest on DTI maps were selected based on areas of normal white matter (NWM) and mild, moderate, and severe axonal degeneration (AxD) on histopathological images. Statistically significant differences were observed between NWM and AxD, and among different severities of AxD. The severity of AxD demonstrated a negative linear correlation with fractional anisotropy and positive linear correlations with spherical index and radial diffusivity; additionally, positive U-shaped correlations were identified between the severity of AxD and mean diffusivity and axial diffusity (AD). These results demonstrate a potential clinical application for DTI in the noninvasive monitoring of histological changes post-SCI. DTI could be utilized for the early diagnosis and assessment of SCI and, ultimately, used to optimize the treatment and rehabilitation of SCI patients.

Acute physiological effects of whole body vibration (WBV) on central hemodynamics, muscle oxygenation and oxygen consumption in individuals with chronic spinal cord injury

Purpose: (1) Investigate the acute effects of whole body vibration (WBV) on central hemodynamic responses, muscle oxygenation and oxygen consumption () in individuals with spinal cord injury (SCI) versus sex, age and activity-matched able-bodied (AB) individuals. (2) Assess the effects of three WBV frequencies on all outcome measures. Methods: Eleven males with SCI and 10 AB individuals were recruited. Subjects completed three WBV exercise sessions at 30, 40 and 50 Hz. Heart rate (HR), mean arterial blood pressure (MAP), stroke volume (SV), cardiac output (CO), and relative changes in oxygenated (Δ[HbMbO2]), deoxygenated (Δ[HHbMb]) and total (Δ[HbMbtot]) heme groups were obtained when steady state was achieved for: pre-WBV sitting, pre-WBV standing, WBV and post-WBV standing. Results: Both groups demonstrated small but significant increases in , Δ[HbMbO2] and Δ[HbMbtot]; but the increases were larger in the SCI group. A significant decrease Δ[HHbMb] was observed in the SCI group. No frequency effect was observed. Conclusion: The WBV responses do not appear sufficient to induce cardiovascular benefits in the SCI population. WBV may be helpful for individuals with SCI in improving lower limb peripheral blood flow and coping with orthostatic hypotension symptoms earlier in their rehabilitation programs.Implications for RehabilitationIncreased muscle oxygenation and blood flow observations in response to WBV suggest a possible application of WBV for increasing lower extremity blood flow and/or oxygen saturation in individuals with SCI.WBV may be incorporated into the rehabilitation programs for reducing thrombosis susceptibility in individuals with SCI.Blood pressure in individuals with SCI appeared to be maintained much better in the upright position when WBV is applied.This could be helpful in the rehabilitation of SCI patients by allowing them to avoid the difficulties of orthostatic hypotension earlier in their rehabilitation programs.

Survival after spinal cord injury in Australia

O’Connor PJ. Survival after spinal cord injury in Australia. Objective To assess survival after spinal cord injury (SCI) in Australia. Design Cohort study of incident cases from 1986 to 1997, with follow-up to the end of 1998. Setting Cases registered by 6 Australian treatment centers for the acute care and rehabilitation of SCI patients. Participants Subjects (N=2892), age 15 years and older, from a national population-based SCI register. Interventions Not applicable. Main outcome measures Cumulative and relative survival proportions and hazard ratios. Results The all-cases cumulative survival proportion was 94% at 1 year and 86% at 10 years; the relative survival proportions were 95% and 92%, respectively. Significant predictors of survival were: age at injury, sex, neurologic level, and extent of lesion. Cox regression modeling revealed a statistically significant reduction in the 2-month (36% reduction, P=.01) and 1-year (27% reduction, P=.04) hazard ratio from 1986 to 1991 to 1992 to 1997. Benchmarking analysis revealed no statistically significant difference in survival experience between the 6 spinal treatment units. Conclusions Further improvement in survival rates can be achieved through better understanding of the predictors, temporal patterns, and causes of death, and by benchmarking. Early deaths have an important impact on overall survival rates, and warrant further study. International standardization of methods is strongly recommended.

Survival after spinal cord injury in Australia*1

O’Connor PJ. Survival after spinal cord injury in Australia. Objective To assess survival after spinal cord injury (SCI) in Australia. Design Cohort study of incident cases from 1986 to 1997, with follow-up to the end of 1998. Setting Cases registered by 6 Australian treatment centers for the acute care and rehabilitation of SCI patients. Participants Subjects (N=2892), age 15 years and older, from a national population-based SCI register. Interventions Not applicable. Main outcome measures Cumulative and relative survival proportions and hazard ratios. Results The all-cases cumulative survival proportion was 94% at 1 year and 86% at 10 years; the relative survival proportions were 95% and 92%, respectively. Significant predictors of survival were: age at injury, sex, neurologic level, and extent of lesion. Cox regression modeling revealed a statistically significant reduction in the 2-month (36% reduction, P=.01) and 1-year (27% reduction, P=.04) hazard ratio from 1986 to 1991 to 1992 to 1997. Benchmarking analysis revealed no statistically significant difference in survival experience between the 6 spinal treatment units. Conclusions Further improvement in survival rates can be achieved through better understanding of the predictors, temporal patterns, and causes of death, and by benchmarking. Early deaths have an important impact on overall survival rates, and warrant further study. International standardization of methods is strongly recommended.

Forecasting of spinal cord injury annual case numbers in Australia

O’Connor PJ. Forecasting of spinal cord injury annual case numbers in Australia. Objectives To forecast annual numbers of cases of spinal cord injury (SCI) and to assess the effect on case mix. Design Cohort of incident cases from 1986 to 1997, with forecasting to 2021. Setting Australian cases registered by treatment centers for the acute care and rehabilitation of SCI patients. Participants A total of 2959 SCI patients, aged 15 years and over, identified through the Australian Spinal Cord Register. Interventions Not applicable. Main outcome measures Incidence and case mix. Results If the recent trends in SCI continue (ie, a 6.21% per annum rate increase in elderly men and a 2.8% per annum rate decrease in young men), the annual number of cases will increase from 253 in 1997 to 464 in 2021. In addition, the case mix would change substantially and the number and proportion of elderly persons with SCI would increase from 32 cases per annum in 1997 (13% of cases) to 233 per annum in 2021 (47% of cases). In addition, there would be a 143% increase in the number of cases of incomplete tetraplegia, from 88 cases per annum in 1997 to 214 cases per annum in 2021. Substantial increases would occur even if the age-specific rates of SCI were stable over the period. Conclusions Population growth, and aging, plus increasing rates of SCI in the elderly will have profound effects on the expected number of SCI patients and their case mix. Treatment centers in Australia will need to plan for these changes. At the same time, there should be increased efforts to prevent SCI in order to ameliorate the problem.